On Mon, 18 Dec 2000 07:49:12 Wayne Wilson wrote: ... >Further reading of this thread convinces me that that the crux of >Andrew's argument is really scale. If you scale the record set down to >just what an individual clinican needs to use (which has been >demonsrated to not even be a single patients complete medical record) >then the amount of records is small enough that I suspect even using >'mediators' is not needed. Wayne, I am proposing to scale down but not in terms of number of records. Instead, I am proposing to scale down the size/scope of the schema. Most clinicians do not routinely use the entire medical dictionary (=big schema). Instead, they collect and use a small subset of data that is relevant to each patient they see. Thus, the data interchange problem is never entire dictionary to entire dictionary. Instead, it is more likely to be 50 data items to 50 data items. *Therefore, the mistaken goal of interchanging entire dictionaries may result in inappropriate trade-offs*. I would further argue that a smaller schema solution can be scaled to cover the entire dictionary (by combining many small schema into a big one). In fact, this is how all (traditional) big schema are constructed through sub-committees and workgroups. >The mediators would best be used to perform >a kind of personal annotation to ease the conscious understanding of >what is being read, thus allowing the clinician to spend less time on >historical review of the record. Sounds worthwhile! Furthermore, a tool that allows this will also allow aggregation of arbitrarily large set of data. >So what we would have then for medical record keeping are systems in >which aggregate functions (defined as being across many clinician's set >of patient's) are not used. What is the difference that you see? If many clinicians use the same forms or mediators are available to merge data from different forms (collected by different clinicians), why can't the system also aggregate data from many clinicians? >IF you will remember the discuss on >principles of confidentiality, this fit's nicely with a patient privacy >model that restricts access to actively involved clinician's, and >eschews personally identifiable aggregation. A bonus benefit! > Aggregate information is still needed for public health and research >purposes, but can be supported with separate systems designed for that >purpose and taking feeds from the individually based record systems. Yes. Specialized systems for data analysis can be constructed using the same OIO technology. However, I think it is still important for all system to be able to exchange data peer-to-peer (i.e. transfer of records from one clinician office to another). > The issues of large scale organization of data management (data >stewardship, etc.) would need to be thought through, as I doubt that >large scale organizational entities will dis appear in health care. Right. Issues of data replication, protection/rights management must be addressed. If we keep this up, these features will become available by OIO-2.0.0 - anticipated release date 1/1/2002 :-). Andrew --- Andrew P. Ho, M.D. OIO: Open Infrastructure for Outcomes www.TxOutcome.Org Assistant Clinical Professor Department of Psychiatry, Harbor-UCLA Medical Center University of California, Los Angeles Join 18 million Eudora users by signing up for a free Eudora Web-Mail account at http://www.eudoramail.com
